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					Open Enrollment Guide

  For Plan Year 2012

 October 3 to October 31, 2011




  Look for 2012 changes on page 4.
Letter from Dean Barnes, Human Resources Director


October 2011


Dear Seattle Housing Authority Employees:

This Open Enrollment Guide is for Regular Administrative, OPEIU and Regular
Maintenance employees of SHA. (This Guide does not cover employees represented
by the Teamsters Union.)

Open Enrollment is your annual opportunity to evaluate the benefits you have, review
upcoming program changes, determine your coverage needs for next year, and make
appropriate benefits changes. This is also a good time to review your Life and
Accidental Death and Dismemberment insurance beneficiaries. Changes you make
during Open Enrollment which is between October 3 and October 31, will be
effective January 1, 2012.

The City’s joint labor/management Health Care Committee has made some coverage
improvements, and added some internal care management programs which will start in
the new year. For example, you’ll see that a new Vision Buy-up option has been added.
Read the Plan Changes section of this Guide (page 4) for all 2012 modifications.

Please take the next few weeks to review your family’s insurance needs. Read through
the Guide to be aware of benefits changes, plan features, and monthly contribution
requirements before making your choices for 2012. Review your family’s health and
dependent care expenses, and identify likely needs for next year. Consider (re)enrolling
in a health or dependent care Flexible Spending Account (FSA) to save money.

If you do not make any changes, your current coverage will continue in 2012, except for
the Flexible Spending Account (FSA) -- to continue your Health Care and/or Dependent
Care FSA, you must submit an FSA enrollment form by Friday, November 11, 2011.

Sincerely,

Dean Barnes

Human Resources Director




NOTE: SHA is subject to the City of Seattle’s eligibility rules and regulations for the
benefits that we receive through them, such as medical, dental, vision, Accidental Death
& Dismemberment, Basic & Supplemental Life insurance, and Basic & Supplemental
Long Term Disability. Any request from an employee that is outside the guidelines set
by the City of Seattle requires written approval from the City

.
Guide Contents
Changes You Can Make During Open Enrollment .................................... 2
Benefits Fairs and Flu Shots Schedule ...................................................... 3
2012 Plan Changes ...................................................................................... 4
Enrollment Options ...................................................................................... 6
Premium Sharing ......................................................................................... 6
Domestic Partner/Partner’s Child Coverage.............................................. 7
Changing Your Plan Choices Outside of Open Enrollment ................... 10
Medical, Dental and Vision Coverage Summaries .................................. 10
Flexible Spending Account Programs ..................................................... 18
Optional Coverages:
        Long-term Disability ..................................................................... 19
        Group Term Life ............................................................................ 19
        Accidental Death and Dismemberment ....................................... 23
        Long Term Care ............................................................................ 24
Deferred Compensation Savings Plan ..................................................... 24
Guaranteed Education Tuition .................................................................. 24
Employee Assistance Program ................................................................ 24
Where to Find More Information About Your Benefits ........................... 25
Who to Contact if You Have Questions.................................................... 25




2012 Open Enrollment Guide                                                                                Page 1
Changes You Can Make During
Open Enrollment
Important note: If you have children age 18 or     Long Term Care insurance
over on your plan that have access to medical      (You can apply at any time, although you are
coverage through their own full-time               guaranteed coverage only if you apply during
employment, you must remove them from              the first 31 days of your hire date.)
SHA’s plan.
                                                       □   Enroll in Long Term Care

Medical coverage                                   Accidental Death & Dismemberment
                                                   insurance
□   Change plans
                                                       □   Change beneficiary designation
□   Add or drop a family member
                                                       □   Add or increase your or family
Dental coverage                                            coverage

□   Change plans                                       □   Drop or decrease your or family
                                                           coverage
□   Add or drop a family member
                                                   Flexible Spending Accounts
Vision coverage                                    (Participants must re-enroll every year)
□   Add or drop a family member                        □   Enroll in Dependent Care Flexible
□   Consider adding new Buy-Up plan                        Spending Account for 2012
                                                       □   Enroll in Health Care Flexible Spending
Supplemental Long Term Disability                          Account for 2012 (Maximum
coverage                                                   contribution reduces to $2,500 in 2013.)
□   Enroll in or drop Supplemental LTD
                                                   Deferred Compensation Savings Plan
□   If adding, a pre-existing exclusion applies:   (Make changes any time during the year)
    see page 19
                                                       □   Change beneficiary designation
Life insurance*                                        □   Enroll or increase contribution
□   Change beneficiary designation                     □   Stop or decrease contribution
□   Add or drop Basic Life or Limited Basic            □   Add or increase Regular Catch-up
    Life coverage                                          contribution (for those within 3 years of
□   Change your Basic Life to Limited Basic                retirement)
    Life (or vice versa)                               □   Add or increase Age 50+ Catch-up
□   Add or increase your Supplemental                      contribution (for those who will be at
    coverage if you have Basic Life                        least 50 on or before 12/31/2012).

□   Drop or decrease your Supplemental             Your Responsibilities :
    coverage
                                                      Update your address, telephone number
□   Add or increase Supplemental coverage for          and emergency contact.
    family members (To do so you must have
    Basic & Supplemental Life)
                                                      Review your paycheck deductions
                                                       frequently.
□   Drop or decrease Supplemental coverage
                                                      Contact HR within 31 days of your family
    for family members
                                                       status change.
*A Medical History Statement is required if           Review your beneficiary information.
adding coverage.                                       Contact Department of Retirement System
                                                       at 800-547-6657 to verify your beneficiary
                                                       information. If you have Deferred
                                                       Compensation, please call 800-547-6657
                                                       to verify your beneficiary information.



2012 Open Enrollment Guide                                                                    Page 2
                              Open Enrollment is Here!
Between October 3 and October 31, you can make changes to your benefits coverages and add or
drop dependents (see checklist on page 2). You must re-enroll if you wish to have a health care and/or
dependent care Flexible Spending Account in 2012.


                    Benefits Fairs and Flu Shots Schedule

        Wednesday, October 5                City Hall – Bertha Knight Landes Conference Room
        9:30 am – 2:30 pm                   600 4th Avenue | 98104
                                            (Enter at 5th and Cherry)


        Tuesday, October 11                 Rainier Community Center
        7:30 am – 10:30 am                  4600 – 38th Avenue South | 98118


        Thursday, October 13                Bitter Lake Community Center
        7:30 am – 10:30 am                  13035 Linden Avenue North | 98133

In addition to the Benefits Fairs, flu shots will be offered at the following locations:

       September 30 – (9:30 – 11:30 am)           Central Office, 1st Flr Conf Rm, 120 6th Ave N
       October 4 (7:00 – 8:00 am)                 MLK Maintenance Facility, 810 MLK Way S
       October 5 (7:00 – 8:00 am)                 OSC Facility, 1300 N 130th Street
       October 10 (9:30 – 10:30 am)               PorchLight, 907 NW Ballard Way



The vaccine will be a mix of serum for H1N1 and seasonal flu.

   Aetna Preventive and Group Health members – shots are free at all flu shot clinics when
    you bring your medical card (covered by your preventive care benefit under these plans).

   Aetna Traditional members can purchase flu shots for $28 by check only. Cash will not
    be accepted.




2012 Open Enrollment Guide                                                                 Page 3
2012 Plan Changes
Aetna Preventive and Traditional Plans

     Add coverage of Gender Reassignment Services
        - Medical and surgical services covered according to Aetna clinical guidelines*

     Add coverage of Temporomandibular Joint Services
        - Non-surgical services covered up to $5,000 lifetime maximum
        - Surgical services covered according to Aetna clinical guidelines*

     Add Aetna’s Radiology Management Program
        - Pre-certification required for high-tech radiology services such as PET scans, MRIs, nuclear
         cardiology, stress echocardiology, diagnostic heart catheterization. (Not required for services
         such as xrays, ultrasounds, and mammograms.)
        - Your network provider is responsible for getting approval

     Add Aetna’s RxCheck Program – Pharmacy Review Program
        - Enhanced safety measures
        - Your physician may receive calls/letters regarding your prescriptions

     Add Aetna’s Specialty Pharmacy Program
        - Provides care management and special handling for high cost drugs; usually injectables
        - Courtesy call after 1st prescription fill at a retail location to review program benefits

     Clarify coverage of Short Term Rehabilitation Services
         - Physical, Massage, Occupational and Speech Therapies for non-chronic conditions
         - Coverage of these services subject to Aetna’s medical necessity review
         - Aetna may request additional documentation at any time; usually with 16th visit
         - Removes 60-visit limit

Group Health Standard and Deductible Plans

     Add coverage of Gender Reassignment Services
        - Medical and surgical services covered according to Group Health clinical guidelines

     Modify coverage of Temporomandibular Joint Services
        - $1,000 annual benefit maximum removed
        - $5,000 lifetime benefit maximum remains in place

Vision Service Plan

     Add an Optional, Buy-up Coverage Option
        - Frames and lenses, or contact lenses, covered every calendar year instead of every 24 months
        - Adds coverage for progressive lenses; increases elective contact lens allowance from
         $120 to $150
        - Eye exams continue to be covered every calendar year
        - Employee pays the additional premium cost of $11.04/month

Long Term Disability Plan
     Reduce Premium -- Monthly rates reduced by 15%

*Visit www.aetna.com/healthcare-professionals/policies-guidelines/clinical_policy_bulletins.html


2012 Open Enrollment Guide                                                                    Page 4
Health Care Reform Notice -- Grandfathered Plan Status Disclosure
The City of Seattle Aetna and Group Health medical plans are “grandfathered health plans” under the
Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable
Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in
effect when that law was enacted. Being a grandfathered health plan means that your plan may not
include certain consumer protections of the Affordable Care Act that apply to other plans, for example,
the requirement for the provision of preventive health services without any cost sharing. However,
grandfathered health plans must comply with certain other consumer protections in the Affordable Care
Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered
health plan and what might cause a plan to change from grandfathered status can be directed to City of
Seattle Central Benefits at (206) 615-1340.




2012 Open Enrollment Guide                                                                  Page 5
Enrollment Options
The plan and dependent coverage elections you make now are for the 2012 plan year. According to IRS
Section 125 regulations, you cannot change your elections outside of open enrollment period unless you
have a qualifying change in family status. Your enrollment options for 2012 and the consequences of
your decision are described below.
ACCEPT medical coverage for yourself and eligible family members by completing and submitting an
SHA Benefits Election Form. If you do not make changes, your plans will remain the same, and you will
pay the designated premium amount.

DECLINE medical coverage for yourself and/or family members (you may not decline dental or vision
coverage).
    If you have no other medical insurance, you will NOT be eligible to enroll in a medical plan until
      the next annual Open Enrollment unless you have a qualifying change in family status as defined
      in the Change in Family Status/Dependent Eligibility section. Enrollment must take place within
      31 days of the qualified change in family status..
    If you have other medical coverage (you may not decline dental or vision coverage) and lose your
      other coverage, you may enroll in a SHA medical plan within 31 days of the loss of the other
      coverage upon providing proof of continuous medical coverage.
    If you have a qualifying change in family status, you may enroll or dis-enroll your eligible
      dependents within 31 days (or 60 days for a newborn or newly adopted child) of that change.
    If you declined SHA coverage and leave SHA employment or go on a leave of absence, you will
      not be eligible to obtain your medical, dental, or vision coverage through SHA under the federal
      COBRA law subsequently. However, if you retire you will be eligible to enroll in a City retiree
      medical plan.


                                      Premium Sharing
The table below shows your monthly premium contributions for 2012. Premium contributions will be
divided into two equal payments and taken from the first two paychecks of the month. Your premium
contributions will be deducted on a pre-tax basis.

                                2012 Monthly Medical Premiums
                               Total
                                          Employee’s Monthly Premium Contribution
           Medical Plan      Monthly
                                                       for Coverage
                             Premium
                                                                   Employee with
                                          Employee, with or      Spouse/Domestic
                                           without children    Partner, with or without
                                                                       children
        City of Seattle
                             $1,049.37          $48.12                  $98.50
        Preventive
        City of Seattle
                              $949.29           $ 0.00                  $32.34
        Traditional
        Group Health
                              $967.83           $48.40                  $99.90
        Standard
        Group Health
                              $891.36           $25.00                  $56.92
        Deductible


2012 Open Enrollment Guide                                                                Page 6
                Domestic Partner Spouse Coverage Information
After-Tax Medical Premium Contribution for Domestic Partner
If you choose to cover a domestic partner who is not your IRS tax dependent, the portion of the
premium deducted from your paycheck (your contribution) that pays for his/her coverage must be taken
“after tax” to comply with IRS regulations. The column headed “Amount of Premium Taken After
Taxes” shows the portion of your monthly premium contribution that will be deducted from your paycheck
after taxes are paid.


                                                    Monthly Premium
                        Medical Plan             Contribution Taken After-
                                                Taxes for Domestic Partner

                City of Seattle Preventive                 $50.38
                City of Seattle Traditional                $32.34
                Group Health Standard                      $51.50
                Group Health Deductible                    $31.92


Taxable Benefit Amount (Coverage Value)
If your domestic partner or your partner’s non-IRS tax dependent’s children do not qualify as your IRS tax
dependents, you will also be taxed on the SHA-paid value of their medical, dental and vision coverage
as required by IRS regulations. The following amounts will be listed on your paycheck as taxable income
and are subject to federal income and Social Security tax withholding. These values have been adjusted
to reflect the premium amounts taken after-tax (as explained above) so you are not taxed twice.




2012 Open Enrollment Guide                                                                   Page 7
Coverage Value with Washington Dental Services Coverage

                 2012 Monthly Taxable Values of SHA Coverage Provided to:
                       Your Non-IRS Tax Dependent Domestic Partner or
                    Your Domestic Partner’s Non-IRS Tax Dependent’s Child
               Type of        Domestic Partner Taxable     Taxable Amount Per
             Coverage                 Amount                      Child
         Preventive Plan              $548.18                    $239.42
         Traditional Plan             $509.14                    $216.59
         GH Standard Plan             $500.55                    $220.82
         GH Deductible Plan           $476.51                    $203.37
         WDS Coverage                  $62.30                     $43.61
         Basic Vision Plan              $4.69                     $3.28
         Buy-Up Vision Plan             $10.66                    $7.46
         Total Taxable Value with WDS & VSP Basic Plan
         Preventive Plan               $615.17                   $286.31
         Traditional Plan              $576.13                   $263.48
         GH Standard Plan              $567.54                   $267.71
         GH Deductible Plan            $543.50                   $250.26
         Total Taxable Value with WDS & VSP Buy-Up Plan
         Preventive Plan               $621.14                   $290.49
         Traditional Plan              $582.10                   $267.66
         GH Standard Plan              $573.51                   $271.89
         GH Deductible Plan            $549.47                   $254.44




2012 Open Enrollment Guide                                                      Page 8
Coverage Value with Dental Health Services Coverage

                 2012 Monthly Taxable Values of SHA Coverage Provided to:
                       Your Non-IRS Tax Dependent Domestic Partner or
                    Your Domestic Partner’s Non-IRS Tax Dependent’s Child

               Type of         Domestic Partner/ Same-Sex    Taxable Amount Per
              Coverage          Spouse Taxable Amount               Child
         Preventive Plan                $548.18                    $239.42
         Traditional Plan               $509.14                    $216.59
         GH Standard Plan               $500.55                    $220.82
         GH Deductible Plan             $476.51                    $203.37

         DHS Coverage                    $75.85                    $53.10

         Basic Vision Plan                $4.69                     $3.28

         Buy-Up Vision Plan              $10.66                     $7.46
                        Total Taxable Value With DHS & VSP Basic Plan

         Preventive Plan                $628.72                    $295.80
         Traditional Plan               $589.68                    $272.97
         GH Standard Plan               $581.09                    $277.20
         GH Deductible Plan             $557.05                    $259.75

                       Total Taxable Value With DHS & VSP Buy-Up Plan

         Preventive Plan                $634.69                    $299.98
         Traditional Plan               $595.65                    $277.15
         GH Standard Plan               $587.06                    $281.38
         GH Deductible Plan             $563.02                    $263.93




2012 Open Enrollment Guide                                                        Page 9
           Changing Your Plan Choices Outside of Open Enrollment
You may only make changes to your benefits elections outside the open enrollment period if family status
changes occur in your family. The changes you can make depend on the status change\ and must be
consistent with it. Call Human Resources (206-615-3328) for more information.

Changes in family status are defined as:

      •    Birth, adoption, placement of a child, or legal guardianship.

      •    Loss of a child, spouse, or domestic partner’s eligibility under another health plan.

      •    Marriage or formation of a domestic partnership.

      •    Divorce, termination of a domestic partnership, or legal separation.


Eligible Dependents

You must be enrolled before you can enroll your dependents. Dependents eligible to be covered under
SHA’s benefit programs are:
      •    Your spouse or domestic partner.

      •    Your biological or adopted children, your spouse or domestic partner’s children, or any child for
           whom you are the legal guardian. The child must be under age 26 and not have access to
           medical coverage through their own fulltime employment.

To cover a spouse/domestic partner, you must complete an Affidavit of Marriage/Domestic Partnership,
available in Ourhouse, or contact Human Resources at (206) 615-3328. You may need to provide proof
of legal guardianship for dependent children.

If the premiums for a domestic partner or partner’s child are taken after taxes, you may drop that
domestic partner or partner’s child any time (without a change in family status) if he/she is not claimed as
your IRS tax dependent.

                             Medical, Dental and Vision Coverage
Benefits Highlights

The following plan highlights will help you compare plan features and decide which plan best fits your
needs. The tables are not a complete description of benefits – see the plan booklets for exclusions,
limitations and additional information.
1




1
    If there is a discrepancy between the information here and in plan booklets, the booklet information will apply.

2012 Open Enrollment Guide                                                                                 Page 10
2012 Medical Benefits Highlights
The purpose of this document is to help you make decisions; it is not a contract. Details are provided in the medical plan booklets in Ourhouse.

           Group Health Cooperative (GHC)*                                       City of Seattle Traditional Plan*                                  City of Seattle Preventive Plan*
       Standard Plan            Deductible Plan                             Aetna In-Network             Out-of-Network                       Aetna In-Network             Out-of-Network
Deductible (per calendar year)
No Deductible                    $200 per person                   $400 per person                     $1,000 per person                $100 per person                      $450 per person
                                 $600 per family                   $1,200 per family                   $3,000 per family                $300 per family                      $1,350 per family
                                 Deductible applies as noted
                                                                   Deductible applies to most services, except as noted. Deductible     Deductible applies to most services, except as noted. Deductible
                                 except for prescriptions,
                                                                   does not apply for prescriptions or when the Inpatient co-pay or     does not apply for prescriptions or when the Inpatient co-pay or
                                 preventive visits, ambulance, and
                                                                   emergency room co-pay applies.                                       emergency room co-pay applies.
                                 durable medical equipment.
Annual Out of Pocket Maximum (OOP Max) Excludes deductible, if applicable. Aetna Copays do not apply towards OOP Max.
$2,000 per person                $2,000 per person                 $1,000 per person                   $2,000 per person**              $2,000 per person                    $3,000 per person*
$4,000 per family                $6,000 per family                 $3,000 per family                   $6,000 per family*               $4,000 per family                    $6,000 per family*
Hospital Copay
$200 per admission                Deductible applies               $200 copay per admission            $200 copay per admission         $200 copay per admission             $200 copay per admission
Hospital Pre-admission Authorization
          Except for maternity or emergency admissions,                   Except for maternity or emergency admissions, your                  Except for maternity or emergency admissions, your
                   must be authorized by GHC                        physician must contact Aetna prior to your admission. Member         physician must contact Aetna prior to your admission Member
                                                                   responsible for obtaining precertification of out-of-network care.   responsible for obtaining precertification of out-of-network care.
Choice of Providers
                                                                   Aetna contracted providers. No Any licensed, qualified               Aetna contracted providers. No       Any licensed, qualified
     All care and services must be approved and/or provided        primary care physician selection provider of your choice.            primary care physician selection     provider of your choice.
              by GHC or GHC designated providers.                  or referrals required. Aexcel*** Expenses paid based on              or referrals required. Aexcel**      Expenses paid based on
        Members may self-refer to most GHC specialists.            specialists must be used in         recognized charges*. You pay     specialists must be used in          recognized charges*. You pay
                                                                   designated specialty areas to       the difference between           designated specialty areas to        the difference between
                                                                   receive the maximum benefit.        recognized and billed charges.   receive the maximum benefit.         recognized and billed charges.
COVERED EXPENSES
Acupuncture
$15 copay for up to 8 visits per $15 copay for up to 8 visits per     Paid at 80%                      Paid at 60%                      Paid at 100% after $15 copay         Paid at 60%
condition per year self-referred. condition per year self-referred.
Additional visits when approved Additional visits when approved               Maximum of 12 visits per calendar year in- and               All acupuncture services are subject to ongoing review and
by plan.                           by plan. Deductible applies.                      out-of-network combined.                                      approval by Aetna for medical necessity.
Alcohol/Drug Abuse Treatment
Inpatient: Paid at 100% after      Inpatient: Paid at 100% after      Inpatient: Paid at 80% after     Inpatient: Paid at 60% after     Inpatient: Paid at 90% after         Inpatient: Paid at 60% after
$200 copay                         deductible                         $200 copay                       $200 copay                       $200 copay                           $200 copay
Outpatient: Paid at 100% after Outpatient: Paid at 100% after         Outpatient: Paid at 80%          Outpatient: Paid at 60%          Outpatient: Paid at 100% after       Outpatient: Paid at 60%
$15 copay                          $15 co-pay. Deductible applies.                                                                      $15 copay
Contraceptives
                For contraceptive drugs and devices,                        IUDs and Depo Provera covered as medical benefits.                IUDs and Depo Provera covered as medical benefits.
                    see Prescription Drug benefit                                     See Prescription Drug benefit.                                    See Prescription Drug benefit.
Durable Medical Equipment
Paid at 80%                        Paid at 80%                        Paid at 80%                      Paid at 60%                      Paid at 90%                          Paid at 60%
Emergency Medical Care
 Urgent Care Clinic
Paid at 100% after $15 copay        $15 copay. Deductible applies.    Paid at 80%                      Paid at 60%                      Paid at 100% after $15 copay       Paid at 60%
                                                                                                                                        (no fee for preventive care)


2012 Open Enrollment Guide                                                                                                                                                            Page 11
           Group Health Cooperative (GHC)*                                  City of Seattle Traditional Plan*                                  City of Seattle Preventive Plan*
       Standard Plan            Deductible Plan                        Aetna In-Network             Out-of-Network                       Aetna In-Network             Out-of-Network

 Emergency Room (copays waived if admitted)
GHC facility: $100 copay     GHC facility: $100 copay            Paid at 80% after $150 copay      Paid at 80% after $150 copay. Paid at 90% after $150 copay        Paid at 90% after $150 copay.
Non-GHC facility: $150 copay Non-GHC facility: $150 copay.                                         If non-emergency, paid at                                         If non-emergency, paid at 60%
                             Deductible applies                                                    60% after copay.                                                  after copay.
 Ambulance
Paid at 80%.                 Paid at 80%.                                  Paid at 80% when medically necessary.                              Paid at 90% when medically necessary.
GHC-initiated non-emergency GHC-initiated non-emergency            Non-emergency transportation must be approved in advance           Non-emergency transportation must be approved in advance
transfers are paid at 100%   transfers are paid at 100%                                   by Aetna.                                                          by Aetna.

Gender Reassignment Services
Covered as any other service;   Covered as any other service;    Covered as any other service;     Covered as any other service;   Covered as any other service;     Covered as any other service;
copays/coinsurance depend on    copays/coinsurance depend on     copays/coinsurance depend on     copays/coinsurance depend on     copays/coinsurance depend on      copays/coinsurance depend on
type and location of service    type and location of service     type and location of service     type and location of service     type and location of service      type and location of service
provided.                       provided.                        provided.                        provided.                        provided.                         provided.
Hearing Aids (per ear, every 36 months)
Up to $1,000                   Up to $1,000                      Up to $1,000                      Up to $1,000                    Up to $1,000                      Up to $1,000
                                                                 In-network coinsurance applies whether purchased in- or out-of- In-network coinsurance applies whether purchased in- or out-of-
                                                                              network. Deductible does not apply.                             network. Deductible does not apply.
Home Health Care
Paid at 100% when authorized.   Paid at 100% when authorized.    Paid at 80%                       Paid at 60%                     Paid at 90%                       Paid at 60%
No visit limit.                 No visit limit.                           Maximum benefit of 130 visits per calendar year                   Maximum benefit of 130 visits per calendar year
                                                                              for in- and out-of-network combined                               for in- and out-of-network combined
Hospital Inpatient
Paid at 100% after $200 copay   Paid at 100% after deductible.   Paid at 80% after $200 copay.     Paid at 60% after $200 copay Paid at 90% after $200 copay.        Paid at 60% after $200 copay
per admission                                                    Physician services paid at 70%                                 Physician services paid at 80%
                                                                 if Aexcel** specialist not                                     if Aexcel** specialist not used
                                                                 used in specialty areas.                                        in specialty areas.
Hospital Outpatient
Paid at 100% after $15 copay    $15 copay. Deductible applies.   Paid at 80% after deductible.     Paid at 60% after satisfaction Paid at 90% after deductible.      Paid at 60% after satisfaction
                                                                 Physician services paid at 70%    of deductible                  Physician services paid at 80%     of deductible
                                                                 if Aexcel** specialist is not                                    if Aexcel** specialist is not
                                                                 used in specialty areas.                                         used in specialty areas.
Hospice
Paid at 100% when authorized    Paid at 100% when authorized     Paid at 80%                       Paid at 60%                     Paid at 90%                       Not covered

Maternity Care (delivery & related hospital)
Paid at 100% after $200 copay Deductible applies.                Paid at 80% after $200 copay      Paid at 60% after $200 copay Paid at 90% after $200 copay         Paid at 60% after $200 copay
Maternity Care (prenatal and postpartum)
Paid at 100% after $15 copay   $15 copay. Deductible applies.    Paid at 80%                       Paid at 60%                     Paid 100% after one $15 copay     Paid at 60%
Mental Health Care (inpatient)
Paid at 100% after $200 copay Paid at 100% after deductible.      Paid at 80% after $200 copay      Paid at 60% after $200 copay Paid at 90% after $200 copay        Paid at 60% after $200 copay
Mental Health Care (outpatient)
Paid at 100% after $15 copay     $15 copay per individual, family                   Paid at 80% after deductible                 Paid at 100% after $15 copay        Paid at 60% after deductible
per individual, family or couple or couple session. Deductible
session.                         applies.



2012 Open Enrollment Guide                                                                                                                                                    Page 12
            Group Health Cooperative (GHC)*                                       City of Seattle Traditional Plan*                                 City of Seattle Preventive Plan*
        Standard Plan            Deductible Plan                             Aetna In-Network             Out-of-Network                      Aetna In-Network             Out-of-Network
Physician Office Visit
Paid at 100% after $15 copay.        Paid at 100% after $15 copay.     Paid at 80%                         Paid at 60%                  Paid at 100% after $15 copay per Paid at 60%
                                     Deductible applies.                                                                                visit (waived for preventive care)
Prescription Drugs (retail)
For a 30 day supply:                 For a 30-day supply:              For a 31-day supply:                                             For a 31-day supply:               Not covered
Generic: $15 copay                   Generic: $15 copay                Generic: 30% coinsurance.           Not covered                  Generic: 30% coinsurance
Brand: $30 copay                     Brand: $30 copay                  Brand: 40% coinsurance                                           Brand: 40% coinsurance
Contraceptive drugs and devices      Contraceptive drugs and devices   The minimum coinsurance is $10,                                  The minimum coinsurance is
are covered subject to the           are covered subject to the        or actual cost of the drug if less.                              $10, or actual cost of the drug if
pharmacy copay.                      pharmacy copay.                   Maximum is $100 per drug.                                        less. Maximum is $100 per drug.
Copays do not apply to OOP           Copays do not apply to OOP        Coinsurance applies to the prescription $1,200 out-of-pocket annual maximum per person, $3,600 per family. Prescription
Max. Smoking cessation               Max. Smoking cessation            Allowance on all non-sedating antihistamines (for allergy symptoms) and Proton Pump Inhibitors (for heartburn relief and ulcer
prescription drugs not subject       prescription drugs not subject    treatment). City pays $20 per month, and plan participant pays remaining; some over the counter medications are also included. $5
to pharmacy copay.                   to pharmacy copay.                copay for generic diabetic drugs and supplies, $15 copay for brand. Many contraceptive products are covered. IUDs and Depo
                                                                       Provera covered under the medical plan benefit. Coinsurance for asthma, anti-high cholesterol, and tobacco cessation drugs 10% for
                                                                       generic and 20% for brand pharmacy.
Prescription Drugs (mail order)
For a 90 day supply:            For a 90 day supply:                   For a 90-day supply:                Not Covered                  For a 90-day supply:                Not Covered
Generic: $45 copay              Generic: $30 copay                     Generic: 30% coinsurance                                         Generic: 30% coinsurance
Brand: $90 copay                Brand: $60 copay                       Brand: 40% coinsurance                                           Brand: 40% coinsurance
                                                                       Minimum is $20 or double the                                     Minimum is $20 or double the
Contraceptive drugs and devices are covered subject to the             cost of the drug if less. The                                    cost of the drug if less. The
pharmacy copay. Copays do not apply to the OOP Max.                    maximum is $200 per drug.                                        maximum is $200 per drug.
Preventive Care
Paid at 100% after $15 copay     Paid at 100% after $15 copay          Mammograms paid at 80%.             Mammograms paid at 60%       Paid at 100% (copay waived)         Paid at 60% for well woman
Covers adult physical and well   Covers adult physical and well                                                                         Covers adult physical and well      care and mammograms
child exams, most                child exams, most                                                                                      child exams, immunizations,
immunizations, hearing exams,    immunizations, hearing exams,                       No other preventive services are covered           digital rectal exams/prostate-      No other preventive services
eye exams, digital rectal        eye exams, digital rectal                                                                              specific antigen test, colorectal   covered
exams/prostate-specific antigen  exams/prostate-specific antigen                                                                        cancer screening.
                                 test, colorectal cancer screening,
test, colorectal cancer screening,
pap smear exam and               pap smear exam and
mammogram.                       mammogram.
                                 Hearing exams subject to
                                 deductible.
Rehabilitation Services (inpatient)
Paid at 100% after $200 copay Paid at 100% after deductible.           Paid at 80% after $200 copay        Paid at 60% after $200 copay Paid at 90% after $200 copay        Paid at 60% after $200 copay
per admission
              Maximum of 60 days per calendar year                                                                                       Maximum of 120 days per calendar year for skilled nursing and
              (combined with other therapy benefits)                                                                                          rehab services in- and out-of-network combined
Rehabilitation Services (outpatient)
Paid at 100% after $15 copay     $15 copay Deductible applies.         Paid at 80%                       Paid at 60%                    Paid at 100% after $15 copay       Paid at 60%
              Maximum of 60 visits per calendar year                   Includes medically necessary physical/massage, speech, and       Includes medically necessary physical/massage, speech,
              (combined with other therapy benefits)                   occupational therapy for non-chronic conditions. Coinsurance     occupational and cardiac/pulmonary therapy for non-chronic
                                                                       does not apply to OOP Max. Coverage of services subject to       conditions. Coverage of services subject to Aetna’s review for
                                                                       Aetna’s review for medical necessity at any time                 medical necessity at any time




2012 Open Enrollment Guide                                                                                                                                                           Page 13
           Group Health Cooperative (GHC)*                                      City of Seattle Traditional Plan*                                  City of Seattle Preventive Plan*
       Standard Plan            Deductible Plan                            Aetna In-Network             Out-of-Network                       Aetna In-Network             Out-of-Network
Skilled Nursing Facility
Paid at 100%. 60 day maximum 60 day maximum per calendar             Paid at 80% after $200 copay       Paid at 60% after $200 copay Paid at 90% after $200 copay        Paid at 60% after $200 copay
per calendar year.               year. Paid at 100% after                       Maximum of 90 days per calendar year for              Maximum of 120 days per calendar year for rehab services and
                                 deductible.                                         in- and out-of-network combined                          skilled nursing in- and out-of-network combined
Smoking Cessation
Paid at 100% for individual      Paid at 100% for individual         Lifetime maximum of one           Not covered                     Smoking cessation                   Not covered
or group sessions                or group sessions                   90-day supply of aids or drugs.                                   prescription drugs covered
Nicotine replacement therapy included in Prescription Drug benefit   Coinsurance 10% generic, 20%                                      subject to 10% generic, 20%
                                                                     brand. See Prescription Drugs.                                    brand drug coinsurance.
Spinal Manipulations
Paid at 100% after $15 copay    $15 copay.                           Paid at 80%                       Paid at 60%                     Paid at 100% after $15 copay        Paid at 60%
                                Deductible applies.
   Self-referral to GHC designated providers. Must meet GHC                       Maximum of 10 visits per calendar year                             Maximum of 20 visits per calendar year
         protocol. Maximum of 10 visits per calendar year.                     for in-network and out-of-network combined.                        for in-network and out-of-network combined.
Sterilization Procedures
Outpatient: Paid at 100% after Outpatient: $15 copay.                Inpatient: Paid at 80% after      Inpatient: Paid at 60% after    Inpatient: Paid at 90% after        Inpatient: Paid at 60% after
$15 copay                       Deductible applies.                  $200 copay                        $200 copay                      $200 copay                          $200 copay
                                                                     Outpatient: Paid at 80%           Outpatient: Paid at 60%         Outpatient: Paid at 90%             Outpatient: Paid at 60%
Temporomandibular Joint Services
 Covered as any other service;  Covered as any other service;         Covered as any other service;    Covered as any other service;    Covered as any other service;       Covered as any other service;
copays/coinsurance depend on copays/coinsurance depend on            copays/coinsurance depend on      copays/coinsurance depend       copays/coinsurance depend on        copays/coinsurance depend on
type and location of service   type and location of service          type and location of service      on type and location of         type and location of service        type and location of service
provided. 5,000 lifetime       provided.                             provided.                         service provided.               provided.                           provided.
maximum                        $5,000 lifetime maximum
                                                                            $5,000 lifetime maximum for non-surgical services                  $5,000 lifetime maximum for non-surgical services
                                                                                     in- and out-of-network combined.                                   in- and out-of-network combined.
Tooth Injury (due to accident)
Not covered                    Not covered                           Inpatient: Paid at 80% after      Inpatient: Paid at 60% after    Inpatient: Paid at 90% after        Inpatient: Paid at 60% after
                                                                     $200 copay                        $200 copay                      $200 copay                          $200 copay
                                                                     Outpatient: Paid at 80%           Outpatient: Paid at 60%         Outpatient: Paid at 100%            Outpatient: Paid at 60%
                                                                                                                                       after $15 copay for office visit.
                                                                                                                                       Other charges paid at 90%
Vision Exam/Hardware
Exam: Paid at 100% after         Exam: Paid at 100% after                           Covered under Vision Service Plan.                                 Covered under Vision Service Plan.
$15 copay. One exam every        $15 copay. One exam every
12 months.                       12 months.
Hardware: Not covered.           Hardware: Not covered.
X-ray and Lab Tests
Paid at 100%                     Paid at 100%. Deductible applies. Paid at 80%                        Paid at 60%                      Paid at 90%                        Paid at 60%
                                                                   Provider responsible for                                            Provider responsible for
                                                                   obtaining precertification of high                                  obtaining precertification of high
                                                                   tech radiology                                                      tech radiology
*    Coverage for any service is subject to the carrier’s determination of medical necessity and adherence to their clinical policy guidelines.
** Applies to Aetna -- Recognized charges are the lower of the provider's usual charge for performing a service, and the charge Aetna determines to be the recognized charge
percentage in the geographic area where the service is provided.
*** Applies to Aetna – Aexcel network, a specialty network of doctors in 13 specialty areas. The coinsurance level will drop 10% for non-Aexcel doctors in the 13 specialty areas
(coinsurance applies to in-network, out-of-pocket maximum). Call 1-877-292-2480for more information about the Aexcel network.
                                            Plan details are in your medical plan booklet in Ourhouse. This document is not a contract.

2012 Open Enrollment Guide                                                                                                                                                          Page 14
                                2012 Summary of Dental Coverage

                                             Dental Plan Comparison
Plan Features                   Washington Dental Service                     Dental Health Services (DHS)
                                (WDS)
Calendar Year Deductible        $50 per person, $150 per family (No           $0
                                deductible for preventive services)
Annual Maximum Benefit          $2,000 per person per year                    No Annual Maximum.
Diagnostic and Preventive       Incentive payments levels                     $10 office visit copay
                                          st
(routine and emergency                  1 Year – 70%                          covers composite fillings in all teeth (posterior
                                          nd
exams, x-rays, cleaning,                2 Year – 80%                          composite fillings additional $15) Two
                                          rd
fluoride treatment, sealants)           3 Year – 90%                          additional cleanings for pregnant women, up
                                          th
                                        4 Year – 100%                         to four cleanings.
Crowns, Inlays, Onlays          Constant 70%                                  $75 (plus $70 noble, $100 high noble, $125
                                                                              upgraded, specialize porcelain if applicable
                                                                              per unit.)
Prosthodonic Services           Constant 50%                                  $125 plus $10 office visit copay (dentures)
(Dentures, Bridges)                                                           $75 plus $10 office visit copay (bridges)

                                                                              ($70 on noble, $100 on high noble metal &
                                                                              titanium, and $125 charge on upgraded,
                                                                              specialized porcelain)
Orthodontia                     Dependent Child(ren) Only                      Available for Child & Adult
                                Plan pays 50%                                 Adult (age 25 and over) $1,800 plus $150 for
                                                                              initial exam, study models and x-rays covers
                                                                              full course of treatment plus $10 copay for
                                                                              each visit (new cases)

                                                                              Orthodontia cases (less than age 25) $1,000
                                                                              copay $150 for initial exam, study models and
                                                                              x-rays covers full course of treatment plus $10
                                                                              copay for each visit (new cases)
Lifetime Maximum                $1,500                                         N/A
Choice of Providers             In-Network: Any contracted provider.          In-Network: Any contracted provider in the
                                Out-of-Network: Expenses paid will be         DHS network.
                                based on actual charges or Washington
                                Dental Service’s maximum allowable fees       Out-of-Network: No out-of-network coverage.
                                for nonparticipating dentists, whichever is
                                less. You will be responsible for any
                                balance remaining.
Periodontics (surgical and      Paid according to incentive payment levels    Paid at 100% after $25 copay for periodontal
nonsurgical procedures for      shown above                                   scaling and maintenance at general dentist. If
treatment of the tissues                                                      referred to periodontist, member pays 20%.
supporting the teeth)
Endodontics (treatment of       Paid according to incentive payment levels    Paid at 100% after applicable copay ($50 for
tissues surrounding root of     shown above, Root canal treatment of          anterior, $75 for bicuspid, or $100 for molar
tooth)                          same tooth covered only once in a 2-year      root canal) If referred to endodontist, member
                                period.                                       pays 20%.
Oral Surgery (routine and       Paid according to incentive payment levels    Paid at 100% after $10 office visit copay for
surgical extractions)           shown above, Root canal treatment of          general dentist. If referred to an oral surgeon,
                                same tooth covered only once in a 2-year      member pays 20%
                                period.
Temporomandibular Joint         Not covered                                   $1,000 annual maximum
(TMJ) Disorders                                                               $5,000 lifetime maximum
Dental Implants                 Constant 50%                                  Call DHS Office for details – fees apply
Other                           N/A                                           Occlusal (night guard) with $350 copay

2012 Open Enrollment Guide                                                                                         Page 15
                                2012 Monthly Dental Premiums
    Dental Plan        Total                  Employee’s Monthly Premium Contribution
                     Monthly
                     Premium
                     Amount
                                Coverage for Employee with or        Coverage for Employee with
                                      without children          Spouse/Domestic Partner with or without
                                                                              children
Washington Dental     $115.28                $0                                   $0
Service
Dental Health         $140.36                $0                                   $0
Services




2012 Open Enrollment Guide                                                                   Page 16
                             2012 Summary of Vision Coverage
NEW this year!
Optional Buy-Up Plan provides more frequent coverage of lenses, frames and contact lenses. It also includes
coverage of progressive lenses. See table below for details. Make your election by October 31 if you want to
choose this new plan coverage starting January 1, 2012. Non-VSP provider allowances have also increased.
Plan Feature                                              Coverage by Provider
                                                VSP Provider                  Non-VSP Provider
Eye exam:                        $10 copay. Exam covered in full.               $10 Copay. Covered up to $50.

 Basic and Buy-Up Plans:
 Covered every
 calendar year
Lenses and Frames:               $25 copay.                                     $25 copay.

 Basic Plan: Covered every Frames covered in full up to contract                Lenses covered up to $50 -
 other calendar year       allowance of $150.                                   $100 depending on type of lens.
 Buy-Up Plan: Covered            Basic Plan: Single vision, lined bifocal,
 every calendar year             lined trifocal lenses are covered in full;     Frames covered up to $70.
                                 progressive lenses not covered*
                           Buy-up Plan: Single vision, lined bifocal,
                           lined trifocal, and progressive lenses are
                           covered in full.
Contact Lenses:            Basic Plan: Contact lens fitting and          Elective contact lenses covered
                           evaluation exam & contact lenses covered      up to $105; includes contact
 Basic Plan: Covered every up to elective contact lens allowance of      lens evaluation exam, fitting and
 other calendar year       $120.**                                       materials. (Medically necessary
                           Buy-up Plan: Contact lens fitting and         contacts covered up to $210.)
 Buy-Up Plan: Covered
                           evaluation exam and contact lenses
 every calendar year
                           covered up to contract allowance of $150.**
Other:                     Basic and Buy-Up Plans: Lens options such as scratch coating, anti-reflective
                           coating, or high density plastic not covered.

                                *If you want any features not covered by the plan, plan ahead and use your
                                FSA to pay for it with pre-tax dollars.
**Medically necessary contacts are covered in full when patient meets specific requirements as determined by
VSP doctor at the time of service.

                                       2012 Monthly Vision Premiums

                 Total Monthly     SHA’s Monthly              Employee’s Monthly Premium Contribution
                   Premium           Premium
 Vision Plan
                   Amount            Payment
                                                     Coverage for Employee        Coverage for Employee with
                                                     with or without children   Spouse/Domestic Partner with or
                                                                                       without children
Basic Plan          $8.68               $8.68                    $0                           $0

Buy-Up Plan         $19.72              $8.68                  $11.04                        $11.04




2012 Open Enrollment Guide                                                                              Page 17
                                 Flexible Spending Accounts
SHA offers two kinds of flexible spending accounts (FSA) – health care and dependent care.

Health Care Flexible Spending Account (FSA)
You can set aside from $120 to $5,000 of pre-tax earnings each year to pay for out-of-pocket expenses such as
dental/orthodontia care; medical, dental and vision copays, deductibles, coinsurance; eye wear, massages, or
any IRS-eligible health care expense. Amounts set aside in the health care FSA reduce your taxable income
and taxes.

Note: Beginning in 2013, health care flexible spending account annual maximums will be reduced from $5,000
per year to $2,500, in accordance with Health Care Reform. The change in 2013 may impact your contribution
decisions for 2012 as you plan for your family’s health care needs and estimate your out-of-pocket health care
expenses for the next few years (examples: orthodontia, elective surgery).

How the Health Care FSA Plan works:
      You select the amount per month you wish to set aside as a payroll deduction, which may not exceed
       $416 per month or $5,000 per year.
      The amount you select is deducted from your paycheck BEFORE federal income and Social Security
       taxes are taken out.
      As you incur eligible expenses, you:
       1. Submit your itemized receipts and reimbursement form directly to Flex Plan Services (SHA’s plan
            administrator for the FSA plans) for reimbursement by check or direct deposit; and/or
       2. Use your health care FSA debit card to purchase health care items, while retaining all your receipts.
      You must sign up for the health care FSA to participate in the program and re-enroll each year during
       open enrollment. Even if you are participating this year, you must re-enroll to participate in 2012.
      If you currently have an FSA debit card and enroll in the 2012 health care FSA, you must check “Yes” in
       the debit card box again in your 2012 FSA enrollment form. New cards will not be sent each year;
       instead the new plan year funds will be loaded to your existing cards once enrollment has been
       processed. You may also call Flex Plan Services at (425) 452-3500 to request a new FSA debit card.
      Your dependents’ health care expenses are also eligible for reimbursement. (Domestic partners and their
       children must meet the IRS dependent eligibility criteria to qualify under the FSA.)

Dependent Care (Day Care) Flexible Spending Account (FSA)
SHA offers the Dependent Care FSA to help make day care expenses more manageable. By using the
dependent care FSA to pay for care for:
       1) children under age 13 or for
       2) any other tax dependent person who is physically or mentally incapable of self-care, you can reduce
       your taxes. (Please refer to IRS Publication 503 for eligible dependent care expenses.)

   Here’s how it works:
    Set aside earnings each month on a pre-tax basis through payroll deduction to pay for planned
      dependent care expenses. Contribute as little as $120 a year or as much as $5,000 maximum per
      family.
    The amount you select is deducted from your paycheck BEFORE federal income and Social Security
      taxes are taken out.
    When you have an eligible dependent care expense, you submit a paid receipt or invoice to Flex Plan
      Services and are reimbursed for the expense, up to the amount currently in your account.
    You must re-enroll each year during open enrollment to participate the following year.
2012 Open Enrollment Guide                                                                           Page 18
                                      Optional Insurance Plans
Long Term Disability (LTD)
As part of your SHA benefits package you receive Basic Long Term Disability coverage to provide you with 60%
of the first $667 of pre-disability earnings per month if you are sick or injured and cannot work. If you are
disabled according to the plan definition, the benefit will combine with other income sources, if any, to pay you
up to $400 per month after a 90-day waiting period while you are unable to work.

Note: Long Term Disability premiums will be reduced by 15% starting January 1, 2012.

Supplemental LTD

You may add to your Basic LTD coverage during open enrollment by purchasing Supplemental LTD coverage.
The Supplemental LTD benefit will combine with other income sources, if any, to provide 60% of your monthly
base pay over $667 (up to a maximum of $8,333 monthly base pay) for a total benefit of up to $5,000 per month.

If you are adding Supplemental LTD coverage more than 31 days after your hire date, you are considered a late
enrollee into the plan and a Pre-Existing Condition Exclusion applies. If you become disabled within a two year
period following the new coverage date with a condition you were treated for during the six month period prior to
Supplemental LTD coverage, it will never be covered under the Supplemental LTD plan.

For example, Abby Smith has worked for HA for five years and decides to add Supplemental LTD coverage
during fall open enrollment. She has been treated for a heart condition for at least six months; if Abby files an
LTD claim in the next two years from the date the new coverage begins related to her heart condition, she will
be eligible for the basic LTD, but never for the Supplemental LTD benefit. If she files a claim related to a
condition for which she had not been treated six months before the new coverage date, Abby may receive
full benefits.

If you are currently eligible to receive a retirement benefit, you may not want to purchase this coverage because
the maximum LTD benefit you would receive would be $100 per month if you elect to receive a
retirement pension.

How Much Will Supplemental LTD Coverage Cost?
The cost for this additional level of earnings protection is figured according to the following formula:
1. Subtract $667 from your base monthly pay.
2. Multiply the remaining amount by .0065. Monthly rates reduced by 15% on January 1, 2012.

For example, if your base pay is $2,000 per month, your monthly premium would be $9.99/month ($2,000 - $667
= $1,333 x .0065 =$8.66/month). Your monthly cost and potential benefit increases each time your
pay increases.

Group Term Life (GTL) Insurance
Benefit choices include three levels of optional term life insurance: Basic GTL, Limited Basic GTL, and
Supplemental GTL. SHA and you share in the cost of Basic GTL or Limited Basic GTL, while you pay the full
cost for any Supplemental Life Insurance.

Basic Term Life Insurance

This optional coverage provides you with a term life benefit amount equal to 1.5 times your annual salary. SHA
contributes 40% of the cost and you pay the other 60%.
2012 Open Enrollment Guide                                                                                 Page 19
Your coverage amount is equal to your annual salary, rounded up to the next $1,000 increment, multiplied by
1.5. Your monthly premium equals $0.066 times each $1,000 of coverage. For example, if your salary is
$25,500, round it up to $26,000. Your coverage amount is $39,000 (Calculation: $26,000 x 1.5 = $39,000).
Your premium is $2.57 per month (Calculation: $0.066 x 39).

Remember, if you are not a new employee, but you want to apply for Basic Group Term Life Insurance during
Open Enrollment, you must complete a Medical History Statement and SHA Benefits Election Form. Medical
History Statements are available in Human Resources.

The following table shows the monthly cost of Basic GTL insurance and the amount you are eligible to buy
based on annual earnings.

         Annual Earnings                        Monthly Cost                Amount of Insurance
        $49,000.01 – 50,000                        $4.95                         $75,000
        $50,000.01 – 51,000                        $5.05                         $76,500
        $51,000.01 – 52,000                        $5.15                         $78,000
        $52,000.01 – 53,000                        $5.25                         $79,500
        $53,000.01 – 54,000                        $5.35                         $81,000
        $54,000.01 – 55,000                        $5.45                         $82,500
        $55,000.01 – 56,000                        $5.54                         $84,000
        $56,000.01 – 57,000                        $5.64                         $85,500
        $57,000.01 – 58,000                        $5.74                         $87,000
        $58,000.01 – 59,000                        $5.84                         $88,500
        $59,000.01 – 60,000                        $5.94                         $90,000
        $60,000.01 – 61,000                        $6.04                         $91,500
        $61,000.01 – 62,000                        $6.14                         $93,000
        $62,000.01 – 63,000                        $6.24                         $94,500
        $63,000.01 – 64,000                        $6.34                         $96,000
        $64,000.01 – 65,000                        $6.44                         $97,500
        $65,000.01 – 66,000                        $6.53                         $99,000
        $66,000.01 – 67,000                        $6.63                        $100,500
        $67,000.01 – 68,000                        $6.73                        $102,000
        $68,000.01 – 69,000                        $6.83                        $103,500
        $69,000.01 – 70,000                        $6.93                        $105,000
        $70,000.01 – 71,000                        $7.03                        $106,500
        $71,000.01 – 72,000                        $7.13                        $108,000


Limited Basic GTL (benefit limited to $50,000):

The value of any life insurance coverage depends on your age (and associated risk of death) and the amount of
the coverage. IRS rules state that the value of any Basic Life Insurance over $50,000, which is paid for by SHA,
is taxable. Because SHA pays 40% of the cost for your Basic GTL, you may owe taxes on your Basic Life
Insurance coverage. To avoid the additional taxes, you may limit your Basic GTL coverage to $50,000 by
signing a notarized Waiver form available in Human Resources. You must also complete and submit a SHA
Benefits Election Form.

Supplemental Group Term Life Insurance (GTL)

SHA offers Supplemental GTL as an additional option. As long as you are enrolled for Basic GTL, you may
purchase this extra term life insurance for yourself and for eligible family members; however, in order to cover
your family members, you must enroll yourself, subject to various election rules. You pay the entire cost for
Supplemental GTL coverage.

2012 Open Enrollment Guide                                                                              Page 20
   You may purchase Supplemental GTL for yourself up to 4 times your base salary. The Supplemental
    coverage amount is rounded down to the nearest $5,000. For example, if your salary is $34,000, you should
    already have $51,000 in Basic coverage ($34,000 times 1.5). Then if you purchase two times your base
    salary in Supplemental coverage, your Supplemental coverage will provide an additional $65,000 in
    coverage ($68,000 rounded down), for a total of $116,000 in Life insurance coverage on yourself through
    SHA If the amount of Supplemental GTL when added to the amount of your Basic GTL would exceed
    $500,000 you will need to complete and submit a Medical History Statement.

   To elect life insurance for your family members, you must be enrolled or have applied for Supplemental GTL
    for yourself.

   You may purchase Supplemental GTL for your spouse/domestic partner in multiples of $5,000 up to a
    maximum of 50% of the amount of Supplemental GTL coverage you purchase for yourself. For example, if
    you purchase $120,000 of Supplemental GTL for yourself, you may purchase up to $60,000 of Supplemental
    GTL for your spouse/domestic partner. (There is no Basic Life insurance coverage for your spouse or
    partner.)

   You may purchase Supplemental GTL for your children equal to $2,000, $5,000 or $10,000 for each child.
    Children may be covered until their 25th birthday.

Costs for Supplemental GTL for you and your spouse/domestic partner are based on your age (and associated
risk of death) and the amount of coverage. Costs for covering eligible children are fixed and the monthly
premium is the same regardless of how many children you cover.


Rules for Electing Life Insurance

 1. Unless you are a new employee, if you sign up for Basic and/or Supplemental GTL during this open
    enrollment period, you will need to complete and submit a Medical History Statement. To elect life
    insurance for your family members, you must be enrolled or have applied for Supplemental GTL.
2. If you want to purchase Supplemental GTL for your spouse/domestic partner, he/she will also need to
    complete and submit a Medical History Statement. If you are a new employee, a Medical History Statement
    is required for your spouse or domestic partner only for coverage in excess of $50,000.
3. If you want to purchase Supplemental GTL for your child(ren), no Medical History Statement is needed.




2012 Open Enrollment Guide                                                                          Page 21
                             Supplemental Group Term Life Insurance
                                  2012 Monthly Employee Cost
                                                     Supplemental GTL for Children
           Employee and Spouse/Domestic                (cost includes all children)
                      Partner

            Your Age            Monthly              Amount of         Monthly cost
                               cost/$1,000           coverage
              18-29               $.032                $2,000              $ .40
              30-34               $.048                $5,000              $1.00
              35-39               $.064
              40-44               $.090               $10,000              $2.00
              45-49               $.152
              50-54               $.232
              55-59               $.360
              60-64               $.552
            65 & over             $.960




2012 Open Enrollment Guide                                                            Page 22
Accidental Death and Dismemberment (AD&D) Insurance
To supplement your Basic and Supplemental Life Insurance, you may purchase AD&D Insurance for yourself,
your spouse/domestic partner, and/or children. AD&D Insurance pays a death benefit (full insurance amount or
“principal sum”) if the insured person dies due to an accident or a percentage of the principal amount if the
covered person loses a limb(s) due to an accident. For example, a person who is covered by AD&D Insurance
would receive 50% of the full insurance amount if he/she lost a limb from an injury relating to an accident. This
coverage may be purchased in addition to or instead of Basic and Supplemental Life Insurance.
You can add or change your AD&D coverage by completing and submitting SHA Benefits Election Form. The
form is available in Ourhouse or contact Human Resources at (206) 615-3328.

Employee Only Coverage
You can cover yourself for amounts from $25,000 to $500,000 (in $25,000 increments).

Family AD&D Coverage
If you elect Family AD&D coverage, the amount of coverage for your covered dependents/domestic partner is a
percentage of your coverage amount as shown below:

          Coverage when      Spouse/ Partner coverage amount      Each Child’s coverage amount relative
          Covered            relative to covered employee’s       to covered employee’s coverage
          Dependents         coverage amount                      amount
          include:
          Spouse/DP Only                   60%                             Not applicable (0%)


          Spouse/DP &                      50%                                     15%
          Children
          Children Only             Not applicable (0%)                            20%


AD&D Coverage Costs
This chart shows the monthly costs for AD&D coverage for employee and family coverage.

                             Accidental Death & Dismemberment Insurance
                                   2012 Monthly Cost to Employees
                        Your Monthly Cost                               Your Monthly Cost
       Principal        Employee      Employee            Principal     Employee      Employee
       Sum:             Only:         and Family          Sum:          Only:         and Family
          $25,000           $0.50         $0.75             $275,000        $5.50         $8.25
          $50,000           $1.00         $1.50             $300,000        $6.00         $9.00
          $75,000           $1.50         $2.25             $325,000        $6.50         $9.75
         $100,000           $2.00         $3.00             $350,000        $7.00         $10.50
         $125,000           $2.50         $3.75             $375,000        $7.50         $11.25
         $150,000           $3.00         $4.50             $400,000        $8.00         $12.00
         $175,000           $3.50         $5.25             $425,000        $8.50         $12.75
         $200,000           $4.00         $6.00             $450,000        $9.00         $13.50
         $225,000           $4.50         $6.75             $475,000        $9.50         $14.25
         $250,000           $5.00         $7.50             $500,000       $10.00         $15.00




2012 Open Enrollment Guide                                                                                Page 23
Long Term Care
SHA offers a Long Term Care (LTC) Program through UNUM Provident company. Long Term Care is defined
as the type of care received when someone needs assistance with what is known as the “Activities of Daily
Living” – basic activities like dressing, bathing, eating and moving around that can be impaired by an accident,
illness or advancing age. Long Term Care is not limited to the elderly. Accidents or unexpected illness can
happen at any time, and at any age. The insurance is voluntary, guaranteed renewable and portable. New
employees enrolling in Long Term care are automatically approved for benefits up to and including $6,000 per
month on a Guaranteed Issue basis. Coverage for benefits higher than $6,000, or benefits not on a Guaranteed
Issue basis will require the completion of a medical questionnaire for evidence of insurability. Coverage levels
for anyone other than the employee will require the completion of the Long Term Care application and Evidence
of Insurability Form.
Long Term Care coverage may be purchased for the employee’s spouse, or domestic partner, employee’s
parent or grandparent, employee’s sibling or child age 18 and over, or the spouse’s/domestic partner’s parent or
grandparent.
Note: any level of coverage applied for which requires the completion of a medical questionnaire is not
guaranteed, but subject to review and approval. Long Term Care packets and enrollment forms are available
upon request in Human Resources.

Deferred Compensation Savings Plan
The State of Washington Deferred Compensation Program (DCP) offers you the opportunity to join together with
the State of Washington to help you plan for a secure financial future. The DCP offers tax benefits to
participants by allowing you to automatically save a portion of your salary and invest it in your choice of various
investments. You may defer up to a maximum of $16,500.00. The minimum deferral is $30.00 per month.
You may start or stop your participation in this program at any time. Remember however, that access to this
money once it is deferred is governed by very strict IRS regulations, and is not readily available to you. For
more information, or to sign up for Deferred Compensation, please contact 1-800-423-1524, or check their
website at www.drs.wa.gov/dcp.

Guaranteed Education Tuition Program (GET)
We all know how important a college education is to Washington’s future generations. The cost of that college
education is increasing an average of seven percent per year. In order to help families prepare for these future
costs, the 1997 Washington State Legislature created the Guaranteed Education Tuition (GET) Program. GET
allows families to purchase college tuition now for use in the future, giving families peace of mind about their
children’s future education.
For your convenience, GET is available through payroll deduction. You can contribute as little as $20 per
month, per account. There is no maximum monthly contribution. Payroll deduction allows you to prepare for
your children’s future higher education needs in a way that is convenient and safe. You decide when you want
the contribution to start or stop. To find out more information, please contact 1-(877)-438-8848 or visit their
website at www.get.wa.gov/ Brochures are available in Human Resources.

Employee Assistance Program (EAP)
SHA offers you and your family the services of an Employee Assistance Program (EAP). An Employee
Assistance Program provides short-term, confidential counseling for you and your family at no out-of-pocket
expense to you. You may use the EAP as soon as you are hired as an SHA employee. Simply call (800) 553-
7798 or (206) 654-4144. You can also visit their Wellspring Family Services website at www.wfseap.org.
You and each of your family members are each entitled to six face-to-face counseling visits, per issue, per year
at no cost to you. The EAP can assist you with issues such as stress, parenting, abuse, aging, drugs/alcohol,
2012 Open Enrollment Guide                                                                               Page 24
grief, marriage, work, finances, depression, relationships, eating disorders and many other issues. All
discussions between you and the EAP therapist are confidential. Personal information is never shared with
anyone at any time, including your employer, without your direct knowledge and approval. (Exceptions are
made only in cases governed by law to protect individuals threatened by violence.)

                Where to Find More Information about Your Benefits
    The Human Resources website provides coverage summaries and informational booklets, as well as
     websites and contact information for each plan. Go to the Benefits pages on Ourhouse.
    Aetna Navigator (AetnaNavigator.com ) is a personalized website packed with health and provider information. Once
     you have registered, you can check the status of your claim, view Explanation of Benefits (EOB) statements, find a
     doctor or pharmacy, compare hospitals, price a prescription drug, sign up for the mail order drug (MOD) program, and
     refill MOD prescriptions. You can access the site 24 hours a day, 7 days a week.
    You can access Group Health’s website at GHC.org and register for MyGroupHealth. Once you’ve registered, you can
     send a secure e-mail to your health care team, refill prescriptions and get drug information, make appointments, view
     lab test results, access a huge database of health information, use health risk assessment and improvement tools,
     and find facility and service information.


                           Who to Contact if You Have Questions
If you have questions, contact the following organizations by phone or obtain information through their web sites.
Aetna                                    877-292-2480            AetnaNavigator.com

Group Health Cooperative                  888-901-4636               GHC.org
Vision Service Plan                       800-877-7195               VSP.com
                                                                     click on “Members and Consumers”
                                          206-522-2300 or            DeltaDentalWa.com
Washington Dental Service (WDS)
                                          800-554-1907

Dental Health Services                    206-788-3444               DentalHealthServices.com/cityofseattle
                                          877-495-4455
WA State Retirement Systems               800-547-6657               www.drs.wa.gov
(PERS)
WA State Deferred Compensation            (800) 423-1524
                                                                     www.drs.wa.gov/dcp
Program                                   (360) 664-7000
Employee Assistance Program,              (800) 553-7798             www.wfseap.org
Wellspring Family Services                (206) 654-4144             User Name: Seattle Housing Authority
Long Term Care
                                          (800) 421-0344             www.unum.com
UNUM Provident
Life, AD&D, LTD                           (206) 615-3328             Human Resources on Ourhouse
Flexible Spending Accounts                (425) 452-3500
                                                                     www.flex-plan.com
Flex Plan Services                        (800) 669-3539
Guaranteed Education Tuition              (877) 438-8848             www.get.wa.gov




2012 Open Enrollment Guide                                                                                     Page 25

				
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